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Can guidelines improve referral to elective surgical specialties for adults? A systematic review
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Clarke, Aileen, Blundell, N., Forde, I., Musila, N., Spitzer, D., Naqvi, S. and Browne, John (2010) Can guidelines improve referral to elective surgical specialties for adults? A systematic review. Quality and Safety in Health Care, Vol.19 (No.3). pp. 187-194. doi:10.1136/qshc.2008.029918 ISSN 1475-3898.
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Official URL: http://dx.doi.org/10.1136/qshc.2008.029918
Abstract
Aim To assess effectiveness of guidelines for referral for
elective surgical assessment.
Method Systematic review with descriptive synthesis.
Data sources Medline, EMBASE, CINAHL and Cochrane
database up to 2008. Hand searches of journals and
websites.
Selection of studies Studies evaluated guidelines for
referral from primary to secondary care, for elective
surgical assessment for adults.
Outcome measures Appropriateness of referral (usually
measured as guideline compliance) including clinical
appropriateness, appropriateness of destination and of
pre-referral management (eg, diagnostic investigations),
general practitioner knowledge of referral
appropriateness, referral rates, health outcomes and
costs.
Results 24 eligible studies (5 randomised control trials,
6 cohort, 13 case series) included guidelines from UK,
Europe, Canada and the USA for referral for
musculoskeletal, urological, ENT, gynaecology, general
surgical and ophthalmological conditions. Interventions
varied from complex (“one-stop shops”) to simple
guidelines. Four randomized control trials reported
increases in appropriateness of pre-referral care
(diagnostic investigations and treatment). No evidence
was found for effects on practitioner knowledge. Mixed
evidence was reported on rates of referral and costs
(rates and costs increased, decreased or stayed the
same). Two studies reported on health outcomes finding
no change.
Conclusions Guidelines for elective surgical referral can
improve appropriateness of care by improving prereferral
investigation and treatment, but there is no
strong evidence in favour of other beneficial effects.
Item Type: | Journal Article | ||||
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Subjects: | R Medicine > RD Surgery | ||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Medical referral -- Research, Surgery, Elective -- Decision making, Systematic reviews (Medical research) -- Great Britain | ||||
Journal or Publication Title: | Quality and Safety in Health Care | ||||
Publisher: | BMJ Group | ||||
ISSN: | 1475-3898 | ||||
Official Date: | 8 March 2010 | ||||
Dates: |
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Volume: | Vol.19 | ||||
Number: | No.3 | ||||
Page Range: | pp. 187-194 | ||||
DOI: | 10.1136/qshc.2008.029918 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Open Access (Creative Commons) | ||||
Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||
Grant number: | SDO/08/1310/072 (NIHR) |
Data sourced from Thomson Reuters' Web of Knowledge
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